Provider Demographics
NPI:1508174285
Name:LEE GHORBANIAN I LTD
Entity Type:Organization
Organization Name:LEE GHORBANIAN I LTD
Other - Org Name:SUNRISE DENTAL OF GRESHAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-644-1126
Mailing Address - Street 1:13908 SE STARK ST
Mailing Address - Street 2:SPACE B
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-2161
Mailing Address - Country:US
Mailing Address - Phone:503-644-1126
Mailing Address - Fax:503-644-1126
Practice Address - Street 1:13908 SE STARK ST
Practice Address - Street 2:SPACE B
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-2161
Practice Address - Country:US
Practice Address - Phone:503-644-1126
Practice Address - Fax:503-644-1126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD7463282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural